HOSPICE FUNDING:
WHAT YOU NEED TO KNOW

While the hospice's source of funds may be the last thing
on your mind, hospices are businesses. The business end of
hospice can affect the care your loved one receives. Hospices
receive funds from government programs or private insurance, from
donations made by the public or other corporations, and from
grants donated by charitable foundations. Hospices are reimbursed
by Medicare, Medicaid, or private insurance for care provided to
the terminally ill.

Except for continuous around-the-clock home nursing care,
which is paid for on an hourly basis, all other services are
reimbursed on a per-diem basis. Hospices are not reimbursed on a
fee for service basis: rather, hospices are paid, on a basis of
how many days the patient is enrolled in the program and received
services: the per-diem basis. In return for payment, Medicare,
Medicaid and private insurance companies expect the hospices to
provide all services which the patient and family need which are
related to the terminal illness. The Centers for Medicare Services (CMS) regulations mandate that
the hospice comply with the regulations.

And the per-diem basis of payment assumes that the hospice
agency will actually provide those services; this payment system
places much trust in the hospice management. However, fewer
services provided to a patient results in more money retained by
the hospice. Obviously, the system can reward fraudulent hospices
with increased income while honest, dedicated hospices provide
full services as required.

Donations to Hospices

While nonprofit hospices can solicit as well as receive
charitable donations, for-profit hospices can only receive
donations. After the death of their loved one, some families
suggest making memorial donations to the hospice they used. This
is a very significant source of funds to the hospice and helps to
cover expenses incurred in running the hospice.

Nonprofit charitable hospices are supposed to provide hospice
services to those persons who do not have coverage and cannot
afford to pay for care. So when you donate to a nonprofit
hospice, there is a greater likelihood that charitable hospice
services will be provided.

When you donate to a hospice, you cannot be sure that
donations made to the local hospice will actually be used for the
purpose you designate. Even if you designate a purpose, there are
legal tricks of the trade, or accounting, which can make it
possible for a hospice to shift the donated money or other money
to other purposes than what you wished. Although there are laws
stating that restricted donations must be used for the purpose
designated by the donor, certain recent court cases have
challenged the strictness with which these laws are enforced.
Practically speaking, the government does not always look into
what a hospice may do with any donations.

While donating directly to a nonprofit hospice allows you to
claim a charitable federal tax deduction, you can only be
sure that your money is used for a particular purpose if you
personally buy something and donate it to the hospice.
Some hospices have several branch locations covering a large
area. If you donate to one hospice, the management may take the
money and transfer it to a completely different location...or it
may use the money to help pay for unreasonably high salaries for
executives.

For-profit hospices have no obligation to provide services to
anyone who does not have coverage from Medicare, Medicaid or
private insurance. They can turn people away and tell people to
go elsewhere. If you do choose to donate to a for-profit hospice,
just remember that the for-profit corporation may take that money
and pay its Chief Executive Officer many hundreds of thousands of
dollars each year in salary and benefits!

No Need to Ever Pay Privately for Hospice Services

Whether or not your loved one has Medicare, Medicaid or
private insurance, you should never have to pay out of your own
pocket for hospice covered services. If a hospice asks you to pay
for private duty nursing out of your own pocket when there are
uncontrolled symptoms, when you already have Medicare, Medicaid
or private insurance, it is very likely committing health care
fraud illegally! It is important that you report this to your
regional U.S. Office of Inspector General and U.S. Attorney's
office. Double-billing is a very real and despicable scam
committed by rogue hospices taking advantage of the dying.
Don't let this happen to you!

Charitable Provision of Hospice Services

If you do not have any coverage by Medicare, Medicaid or
private insurance, a nonprofit hospice can provide services to
you FREE OF CHARGE as part of its charitable mission. The
nonprofit status of the hospice often requires it to provide
charitable services. Find a larger nonprofit hospice if you have
no coverage; the nonprofit hospices are dedicated to the mission
of serving those in need.